Individual
AVERY GRACE MACINTOSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1040 SUMMIT AVE, MAHTOMEDI, MN 55115-1544
(651) 815-3171
Mailing address
1040 SUMMIT AVE, MAHTOMEDI, MN 55115-1544
(651) 815-3171
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
03/06/2024
Last updated
03/06/2024
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